What is it?

Developmental dysplasia of the hip (DDH) is a condition where the ball and socket joint of the  hip doesn't properly form in babies and infants. Essentially, the socket remains flat or shallow if the ball is not properly applied to it during development. It's sometimes known as Congenital Dislocation of the Hip (CDH), or hip dysplasia. 

Roughly three in every 1,000 babies have DDH that needs treating.

Without treatment, DDH may lead to problems later in life, including:

  • developing a limp
  • hip pain – especially during the teenage years
  • painful and stiff joint (osteoarthritis )
  • If the hip socket is very shallow (acetabulum) it could result in arthritis severe enough to require a hip replacement at a much earlier age than usual.

But the good news is that this is generally an isolated condition without related medical issues. With early diagnosis and treatment, most children are able to develop normally and have a full range of movement in their hip. Also, it is rarely painful for the baby or child, even when the hip is dislocated.

How is it diagnosed?

It’s standard practice for a newborn’s hips to be assessed in the first week, so hip dysplasia in babies is often discovered early on. Another hip examination is carried out at 6-8 weeks, but dysplasia and dislocation can occasionally develop after this in some children.

This condition is ‘silent’, so can be hard to detect – it doesn’t cause pain and won’t usually even prevent them from learning to walk at a typical age.

An ultrasound scan is usually recommended within a few weeks if:

  • the hip feels unstable
  • there's a family history of childhood hip problems
  • your baby was born in the breech position (either bottom first or feet first) or spent time in the breech position as a fetus (even if the hips seem normal on examination at birth)
  • If there are signs in the feet or ankles that the baby was compressed in the womb, for example “positional talipes”
  • you've had twins or a multiple birth and one or more was breech

X-ray screening is generally used for diagnosis if the child is older than 6 months.

Treatment

A treatment plan will be developed quickly post-diagnosis and will depend greatly on the age of the child at the point of diagnosis. Harnesses, braces and non-operative solutions may be viable for children up to 12 months, but after this options may be reduced to anterior open reduction or bone surgery.

A fabric splint known as a Pavlik harness worn constantly for several weeks is a common treatment for young babies. Surgery may be needed if your baby is diagnosed with DDH after they're six months old, or if the Pavlik harness hasn't worked. The most common surgical technique is known as reduction, which involves placing the ball of the femur back into the hip socket. Some children may also require bone surgery (osteotomy) during an open reduction, or at a later date to correct any bone deformities.

 

Causes and prevention

Genetics play a role but are not a direct cause. This condition cannot be prevented completely, but being aware of known causes and treating hips well can help, as can special screening at birth if multiple risk factors are highlighted (for example, if the first born, girl of a family with a history of DDH is born breech she may be considered high risk).

It is worth noting that this condition is twice as common in girls as boys and more common in first born children.

Concern has also been raised about methods of swaddling and carrying babies and there are clear guidelines for best practice.

Where to go for support

There are a number of support groups available that provide a wealth of information and experiences of other parents who have been through a similar experience.

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